Nutrição no puerpério imediato: requerimento energético, oferta e consumo alimentar em uma maternidade de referência

Abstract

Introduction: Nutritional attention can prevent weight retention and other complications in the postpartum period, but the lack of nutritional recommendations for this population precludes an effective intervention. Objective: To characterize the nutritional status and the energy requirement of immediate postpartum women in interface with the food suply in a reference maternity. Methods: A cross-sectional study with immediate postpartum women with information about socioeconomic and demographic status, practice of breastfeeding (BF), food consumption (increased appetite after delivery, perception about the hospital food supply and 24-hour recall), anthropometry (pre-gestational and current weight, body composition and gestational weight gain) and nutritional requirements (indirect calorimetry - IC and prediction equations). The nutritional composition of the food supply was verified by weighing the meals. Results: The data allowed the elaboration of two original articles. In the first article, 79 women were included, of which 96.9% reported practice of BF. Such practice was not associated with energy requirement (p>0.05). The best predictors of resting energy expenditure, which median measured by IC was 1224.0 (CI95% 1157.4-1330.0) kcal, were Harris-Benedict with the lowest difference (p=0.876), the best median of adequacy (99.8%) and better intraclass correlation (ICC=0.289), and Schofield with a higher percentage of accuracy (33.3%) and lower opposite agreement (7.6%). All prediction equations presented low agreement and accuracy and, for the most part, the results were overestimated. In the second article, 98 women were included, of which 39.2% were overweight before pregnancy and 69.4% after delivery (p<0.001). The adequacy of the food supply indicated excess of energy, carbohydrate, lipid and saturated fatty acids (SFA) for 100% of the sample, and protein for 58.4%. In relation to the food intake, energy, lipid and SFA were above the recommendation for 93.5% of the participants, carbohydrates to 83.1% and proteins to 37.7%. Women who reported increased appetite after childbirth (38.1%) had higher intake of energy, carbohydrate, lipid and SFA (p<0.05), but no difference in energy requirement (p=0.620). There was no association between the practice of BF and food intake or increased appetite (p>0.05). Conclusion: The high prevalence of inadequate nutritional status in the sample and overestimation of the energy requirement by the prediction equations shows the relevance of continuous studies on the subject in order to propose more adequate methods of health care for this population. Excesses were evidenced in the food suppy and intake, suggesting the importance of offering food with low energy density and source of fiber that can promote satiety without exacerbating the caloric supply in this life cycle. Key Words: postpartum period; maternal nutrition; energy requirement; food consumption; nutritional status.